title: Understanding safety culture in long-term care: a case study.
abstract: OBJECTIVE
  This case study aimed to understand safety culture in a high-risk secured unit for cognitively impaired residents in a long-term care (LTC) facility. Specific objectives included the following: diagnosing the present level of safety culture maturity using the Patient Safety Culture Improvement Tool (PSCIT), examining the barriers to a positive safety culture, and identifying actions for improvement.
  
  
  METHODS
  A mixed methods design was used within a secured unit for cognitively impaired residents in a Canadian nonprofit LTC facility. Semistructured interviews, a focus group, and the Modified Stanford Patient Safety Culture Survey Instrument were used to explore this topic. Data were synthesized to situate safety maturity of the unit within the PSCIT adapted for LTC.
  
  
  RESULTS
  Results indicated a reactive culture, where safety systems were piecemeal and developed only in response to adverse events and/or regulatory requirements. A punitive regulatory environment, inadequate resources, heavy workloads, poor interdisciplinary collaboration, and resident safety training capacity were major barriers to improving safety.
  
  
  CONCLUSIONS
  This study highlights the importance of understanding a unit's safety culture and identifies the PSCIT as a useful framework for planning future improvements to safety culture maturity. Incorporating mixed methods in the study of health care safety culture provided a good model that can be recommended for future use in research and LTC practice.
authors.affiliation: From the *Health and Rehabilitation Sciences Graduate Program, †School of Health Studies, Faculty of Health Sciences, University of Western Ontario; and ‡School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, Ontario, Canada.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Halligan
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zecevic
authors.forename: Anita R
authors.initials: AR
authors.lastname: Kothari
authors.forename: Alan W
authors.initials: AW
authors.lastname: Salmoni
authors.forename: Treena
authors.initials: T
authors.lastname: Orchard
mesh_terms: D002170:Canada; D003469:Culture; D017144:Focus Groups; D006801:Humans; D008134:Long-Term Care; D009735:Nursing Homes; D015279:Organizational Culture; D061214:Patient Safety